Referral to Palliative Care Infrequent in Patients with Idiopathic Pulmonary Fibrosis Admitted to an Intensive Care Unit

Zhan Liang, Leslie A. Hoffman, Mehdi Nouraie, Daniel J. Kass, Michael P. Donahoe, Kevin F. Gibson, Melissa I. Saul, Kathleen O. Lindell

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Background: Palliative care has been recommended as a means to assist patients with idiopathic pulmonary fibrosis (IPF) in managing symptom burden and advanced care planning. Timing of referral is important because although most patients display a gradually progressive course, a minority experience acute deterioration, an outcome associated with high mortality. Aim: To describe characteristics of IPF patients referred to a specialty lung disease center over a 10-year period who experienced acute deterioration and subsequent intensive care unit (ICU) admission, including frequency and timing of referral to palliative care. Design: Retrospective review. Setting/Participants: We identified 106 patients admitted to the ICU with acute deterioration due to a respiratory or nonrespiratory cause. Variables examined included demographics, date of first center visit, forced vital capacity, diffusing capacity of the lung for carbon monoxide (DLCO), and palliative care referral. Results: ICU admission occurred early (median 9.5 months) and, for 34%, within four months of their first center visit. For nearly one-half of these patients, ICU admission occurred before their third clinic visit. Only 4 (3.8%) patients received a palliative care referral before ICU admission. The majority (77%) died during ICU admission. With exception of the relationship between DLCO% predicted at first visit and time to ICU admission (r = 0.32, p = 0.005), no variables identified those most likely to experience acute deterioration. Conclusion: Due to high mortality associated with ICU admission, patients and families should be informed about palliative care early following diagnosis of IPF.

Original languageEnglish (US)
Pages (from-to)134-140
Number of pages7
JournalJournal of palliative medicine
Volume20
Issue number2
DOIs
StatePublished - Feb 2017
Externally publishedYes

Keywords

  • advanced care planning
  • idiopathic pulmonary fibrosis
  • intensive care unit
  • palliative care

ASJC Scopus subject areas

  • Nursing(all)
  • Anesthesiology and Pain Medicine

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